When Connecticut lawmakers raised the annual licensing fee for health care professionals by $5 last year, they assigned the additional money to go to a confidential assistance program for health care practitioners whose medical, mental health or substance abuse issues could prevent them from practicing safely.

But so far, the program has yet to receive any of the money. And its executive director said that without the funding, the program could end up having to scale back the services it offers, limit the number of people it serves, or take more drastic action.

“This is really very worrisome for us,” said Maureen Sullivan Dinnan, executive director of HAVEN, the Health Assistance InterVention Education Network. “We have seen a great increase [in referrals], so our already-strained staff is more strained.”

HAVEN, a nonprofit, is currently funded by fees from participants and donations from hospitals. The $5-per-license funding arrangement accompanied another change passed last year that expanded the types of health care professionals who must report situations in which a health care worker might be unable to practice safely. In many cases, that requirement can be met by notifying HAVEN, rather than the state health department.

The additional $5 in license renewal fees took effect Oct. 1 and was projected to bring in $450,000 this fiscal year, according to the legislature’s nonpartisan Office of Fiscal Analysis. The legislation requires the state Department of Public Health to transfer the money collected to HAVEN on the last day of January, April, July and October.

But the January payment was not made. Asked about the situation this week, Maura Downes, a spokeswoman for the state Department of Public Health, said the department had reached out to the governor’s budget office “for further guidance on this issue.”

Chris McClure, a spokesman for Gov. Dannel P. Malloy’s budget office, said the state has been seeking to enter into a contract with HAVEN. But so far, the process has been “fruitless,” he said.

“As we continue to diligently pursue a balanced budget in a new economic reality, we must ensure that those receiving taxpayer dollars are accountable and responsible,” McClure said. “We will continue to work with HAVEN to elucidate the necessity for a contract and allay their concerns with signing an agreement with the state to receive taxpayer money. We hope the negotiations are quickly resolved and the relationship is long-lasting to yield positive outcomes.”

'Our financial struggle is overwhelming'

Correspondence between HAVEN and the health department show disagreements about what would be required for the money to be transferred.

On Feb. 5, five days after the January fund transfer was to have taken place, Sullivan Dinnan wrote to Public Health Commissioner Dr. Raul Pino, asking how much had been collected in fees and when they would be transferred to HAVEN. Since the law change expanding the reporting requirements, she wrote, “[W]e are seeing a dramatic increase in referrals for 2016. Our current staff is struggling to meet this important mission.”

In a reply dated Feb. 11, Pino commended HAVEN “for an excellent program,” and said the department had established an account to deposit the $5 fees into. He said a computer program was being finalized to collect information on how much money was in the account. And he wrote that payments to HAVEN would be based on verified expenditures, requiring HAVEN to provide comprehensive financial reports to the health department based on an approved budget that would have to be negotiated.

In response, Sullivan Dinnan wrote that the department should be aware of how many licenses were granted or renewed after Oct. 1, “and computing the five dollar fee would appear to be straightforward. It is unclear why a computerized program would create a delay in the computations, or delay the transfer of funds.”

She added that state law requires the money to go to HAVEN, and said the department’s position that payments be based on verified expenses “appears to violate the Public Act.”

“Although HAVEN will not be negotiating our budget with the Department, HAVEN will provide comprehensive reports to show that the money required by law to be transferred to HAVEN is used for the purposes required by law,” Sullivan Dinnan wrote. “We understand the importance of demonstrating that we are using the funds appropriately.”

HAVEN later submitted a $1.8 million budget listing "expected needs" for 2016, which Sullivan Dinnan described in an interview as a "wish-list" budget. According to a 2014 tax filing, the most recent available, HAVEN spent $576,738 and received $474,972 in program revenue and $138,825 in contributions and grants.

Sullivan Dinnan also requested a meeting with the department. In another message, dated March 16, she asked when HAVEN would get a response.

“Our financial struggle is overwhelming and we are considering limiting intakes,” she wrote.

A health department official, Mary Ann Harward, later wrote to Sullivan Dinnan that the agency was working with a credit card company to verify licensee payments. She wrote in a subsequent email that “very little can be accomplished at this time,” and that the department would prefer to meet “at a future date when discussions can lead to meaningful results.”

After Sullivan Dinnan made additional requests for a meeting, Pino replied that “DPH has been in constant communication with HAVEN in regards to this issue,” and cited technical difficulties with a state vendor for the transactions.

Sullivan Dinnan disputed Pino's characterization of the level of communication.

Professional groups concerned

The funding situation prompted leaders of four health care professional organizations to write to legislators, seeking an accounting for the money collected and for it to be transferred to HAVEN.

“As substance use disorders alone are expected to affect approximately 10% of health professionals over the course of their careers, thousands of our members need help,” leaders of the Connecticut State Dental Association, Connecticut State Medical Society, Connecticut Veterinary Medical Association and Connecticut Nurses’ Association wrote. The groups were involved in the creation of HAVEN, which was established through legislation in 2007.

They added that they did not object to the additional licensing fee last year because the money would be going to HAVEN, which they said had seen an increase in demand for services that exceeded both expectations and available resources.

“Listen, it’s five bucks, but to HAVEN, it’s the world,” said Carol Dingeldey, the dental association’s executive director.

HAVEN does not provide medical treatment, but takes referrals and helps to coordinate health care professionals' treatment and post-treatment care, including random drug testing. HAVEN also makes a determination about when a person can return to practice, and might work with a person for up to five years.

HAVEN currently has five staff members. It also relies on about 20 volunteers, including a 70-year-old nurse practitioner who spends about 15 hours per week with the organization, and a physician who serves as the medical review officer and meets with doctors referred to the program – but who does it in addition to his fulltime job elsewhere, Sullivan Dinnan said. Ideally, she said, the additional money from fees would allow the organization to hire more staff, including a medical director.

“I got a call from a hospital about a doctor on Friday, who they want us to be able to see today, but my volunteer’s available tomorrow,” Sullivan Dinnan said Monday. With someone on staff, she added, a person could be seen on the same day as the call.

Last year, the program worked with approximately 465 health care professionals, she said; it currently has about 300 active participants.

The program received 96 referrals in 2015 and 41 this year as of mid-April.

Because many people are reluctant to refer a colleague, people might call several times to ask hypothetical questions before giving the staff a name. At times, she said, HAVEN’s three-line phone system is busy, but the program doesn’t have the funding to upgrade it.

If the additional money from licensing fees does not come through, Sullivan Dinnan said, HAVEN would probably have to make “hard decisions” about whether to curtail services. “Do we limit the kind of referrals that we will take? Or just have to close after a certain number of referrals?” she said.

Is closure an option?

“I hate to say that out loud,” she said.

“We would take everything we could in order to avoid that,” she said, but added, “I can’t deny that that’s a potential outcome.”